What are we willing to pay for the quality of death we want?

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  • Mohamud Verjee, MD, MBA, CCFP, FCFP says:

    While I fully appreciate the context in which the article was written, there is much more to looking after people who choose to die at home. Some don’t want to stay in hospital, or a hospice. I have accepted all my patients for palliative care at home when practical, in collaboration with specialized nurses, hospital support, pharmacists, social worker, and other advocates. You cannot separate the task of terminal care and the impact on the family at home, most of whom are dedicated to looking after a loved one. However, they need support too, and the professional carers are not excluded. That was before Covid-19. Being a UK trained physician, and used to home visits, the trend was less apparent in Canada in the younger generation of family doctors when I moved to Canada in the 1990s. The amount of knowledge, experience, degree of connection, communication, empathy, and compassion is not something that can be turned on like a tap. The delivery of all has to come from within the carer, and it can be distressing too, but it is a commitment. I recall several occasions when I, as the physician of care, have been spontaneously comforted by the patient or their relatives. Those are humbling and yet most professionally fulfilling moments, creating learning opportunities to pass on to upcoming family physicians, especially residents in training. It is not so much a question of money but how we can manage with available resources. Whatever the cost, whether in hospital or at home, from child to geriatric, it is the quality of healthcare, respect, dignity given, and self-esteem of the patient that is integral to the success in delivering what we are trained to do. We have to understand that governments cannot provide for every need – that is reality. We do need to be innovative, demonstrate leadership in our communities, building trust with the authorities while remaining compassionate and focused on the task in hand.

  • Paul Mann says:

    just great. p

  • Paul Mann says:

    great article. paul

  • Wayne Martin says:

    Amen…for your efforts. Keep them up

  • Margaret says:

    Huge amounts of government funding should be given to home care at end of life. Nobody, with great supportive nursing care, would choose to die in hospital.
    A very good and timely article

  • Darren Cargill says:

    TY Drs. Hsu and Isenberg. I agree 110% and yes, while that may not be possible according to some, when it comes to palliative care, it seems like we always need to do more than other areas of medicine to be noticed and taken seriously.

    Community-based palliative care is what patients want and it is better for the health care system as a whole. Yet, a 2019 HQO report showed that following modest gains, access to community-based palliative care has stalled.

    The only question that remains now: red pill or blue pill.


  • Paul Mann says:

    I think this is a bit patronizing.While not blast the Feds and the Province that this is a dire situation and do not beg. Demand funds. PMM

    • Darren Cargill says:

      Hi again Paul,

      As someone who has “blasted” government often past ten years, I can tell you this approach does not work, at least not often. I see this happening now with LTC advocates and the escalating rhetoric and ad hominem attacks on politicians.

      I would steer advocates towards working with government rather than attacking them. This does not mean we stopping pointing out the gaps or criticizing plans that fall short. Rather, the advocacy must be productive rather than simply rancorous. We must provide solutions, not just criticism.

      I hope you find this helpful.

  • Paul Mann says:

    Not bad. How about an article on the state of Long term care for patients at home who need daily help ? LTC at home for special needs children who may well die if nothing is forthcoming is abherrant. A blight on “universal health care”. PMM


Sarina R. Isenberg


Sarina R. Isenberg, PhD, is a Scientist at the Temmy Latner Centre for Palliative Care at Sinai Health and an Assistant Professor in the Department of Family and Community Medicine at the University of Toronto.

Amy T. Hsu


Amy T. Hsu, PhD, is an Investigator at Bruyère Research Institute, faculty in the Department of Family Medicine at the University of Ottawa, and holds the University of Ottawa Brain and Mind-Bruyère Research Institute Chair in Primary Health Care Dementia Research.

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